EM:RAP for Morris Leibowitz

Morris Leibowitz, your subscription expired on September 1, 2021. Renew now for continued access to the best content in emergency medicine. https://www.emrap.org/subscribe

Mel and Swami give us an update on booster shots. 1. Breaking News August 19th: Booster Update Anand Swaminathan, MD FAAEM • Mel Herbert, MD MBBS FAAEM

In this month’s snack, Ilene discusses updates to pediatric asthma care from Global Initiative for Asthma (GINA) 1. Global Initiative for Asthma Pediatric Guidelines Ilene Claudius, MD

The way we approach febrile infants has traditionally been highly variable. Historically, these patients were admitted and many underwent lumbar puncture. New guidelines published in August 2021 by the American Academy of Pediatrics (AAP) suggest that not every patient younger than 2 months of age will require that. Drs. Ilene Claudius and Jessie Werner discuss the main points and potential practice changers in the article that may allow physicians to “safely do less.” 1. New AAP Guidelines for Management of Pediatric Fever Ilene Claudius, MD • Jessie Werner, MD

In this episode of C3, Jess, Mel, and Stuart tackle a subject at the very core of emergency medicine - the patient in full cardiac arrest. We start with the basics of management and the search for a reversible cause and then dive more deeply into some of the controversies involved in running a code. 1. Approach to the Critical Patient and Key Concepts 2. Diagnosis and Treatment 3. Deep Dive: Airway, Breathing, and Defibrillation 4. Deep Dive: Medications 5. Return of Spontaneous Circulation 6. Review Jessica Mason, MD • Mel Herbert, MD MBBS FAAEM • Stuart Swadron, MD, FRCPC

Morris Leibowitz, your subscription expires on September 1, 2021. Renew now for continued access to the best content in emergency medicine. https://www.emrap.org/subscribe

August ROP includes a case on abnormal uterine bleeding in postmenopausal patients, thyroid medicines, the downsides of chronic acetaminophen use, mental health in athletes, a mass casualty incident, and 10 paper reviews relevant to your practice. 1. August Introduction 2. Reviews and Perspective with Hobart Lee: Thyroid Meds Part 1 3. The Generalist: The Downsides of Chronic Acetaminophen Use 4. Mental Health in Athletes 5. Rural Medicine: Mass Casualty Incident 6. Abstract 1: Vitamin C in Adults With Iron Deficiency Anemia 7. Abstract 2: Screening for Atrial Fibrillation in the Older Population 8. Abstract 3: Informal Caregiving for People With Life-Limiting Illness 9. Abstract 4: Fluticasone Furoate Nasal Spray For Persistent Allergic Rhinitis 10. Abstract 5: Effects of Psilocybin-Assisted Therapy on MDD 11. Abstract 6: Meniscal and Mechanical Symptoms Associated with Cartilage Damage 12. Abstract 7: Association of Air Pollution with Age-related Ocular Changes 13. Abstract 8: Association of NSAIDs with Kidney Health in Ambulatory Older Adults 14. Abstract 9: Androgenetic Alopecia In Transgender/Gender-Diverse Patients 15. Abstract 10: ACG Clinical Guideline: Management of Irritable Bowel Syndrome 16. August Summary 17. ROP 2021 August Farsi Edition Anjali Oberai, MD • Brandon Grove, MD • Dannica Switzer, MD • David Boyle, MD • Dusty Narducci, MD • Heidi James, MD • Hobart Lee, MD • Ken Milne, MD • Michel Lapierre, RN • Razieh Hadian, MD • Reza Roodsari, MD • Steve Brown, MD, FAAFP • Vanessa Cardy, MD, FCFP, FRRMS

Welcome to August EM:RAP! This month Jan and Swami cover electrical storm, insulin pumps, euglycemic DKA, AMS, and more... 1. August Introduction 2. Rural Medicine: Mass Casualty Incident 3. Cardiology Corner: Electrical Storm 4. Hand Washing: The Final Showdown 5. ECMO Update 2021 6. Upper Extremity DVT 7. EMA July Ultra Ultra Summary 8. Pediatric Pearls: Insulin Pumps 9. CorePendium Spotlight: Associated Acute Kidney Injury Contrast 10. Rick’s Rants: Teamwork and Defining Roles in the ED Part 2 11. Not Your Typical AMS 12. Euglycemic DKA 13. August Mailbag 14. August Mega Summary 15. EM:RAP 2021 August German Edition 16. EM:RAP 2021 August PA Edition 17. EM:RAP 2021 August French Edition 18. EM:RAP 2021 August Spanish Edition 19. EM:RAP 2021 August Farsi Edition 20. EM:RAP 2021 August Aussie Edition 21. EM:RAP 2021 August Canadian Edition Amal Mattu, MD FAAEM • Amit Maini, FACEM • Anand Swaminathan, MD FAAEM • Anjali Oberai, MD • Brit Long, MD • Clint Kalan, PA • Daniel McCollum, MD • Dannica Switzer, MD • Darryl Macias MD • David Boyle, MD • Derek Blanchet, MD • Dorothea Hempel, MD • Fred Wu, PA-C • Gita Pensa, MD • Haroun Zayed, MD • Ilene Claudius, MD • Jan Shoenberger, MD • Jessie Werner, MD • Martha Roberts, NP • Mel Herbert, MD MBBS FAAEM • Michel Lapierre, RN • Mike Sharma, PA-C • Reza Roodsari, MD • Rick Bukata, MD • Roshanak Benabbas, MD • Ryan Pedigo, MD • Ryan Spangler, MD • Scott Weingart, MD • Sergio Alvizu, MD • Skyler Lentz, MD • Susy DeMeester, MD • Thomas Fleischmann, MD • Tobias Becker, MD • Vanessa Cardy, MD, FCFP, FRRMS • Zack Shinar, MD

August EMA covers 24 great papers, abstracted and dissected by Mike and Sanjay. Jenny and Jess follow up with their Ultra Summary and Ken and Swami discuss post hoc power calculations. 1. Introduction 2. Abstract 1: Oral Corticosteroids in Acute Preschool Wheeze: A Randomised Trial 3. Abstract 2: Association of Intravenous Radiocontrast with Kidney Function 4. Abstract 3: Adding IV Corticosteroids to H1 Antihistamines in Acute Urticaria 5. Abstract 4: Association of Oral Corticosteroids with Adverse Events in Children 6. Abstract 5: Most Patients Meeting Sepsis Criteria Aren't Diagnosed with Sepsis 7. Abstract 6: Intradermal Sterile Water Injection for Low Back Pain in the ED 8. Abstract 7: Removal of a Warning Against Cephalosporins in Penicillin Allergy 9. Abstract 8: IM Droperidol or Olanzapine for Acute Agitation in the ED 10. Abstract 9: Sucralfate to Improve PO Intake in Kids with Infectious Oral Ulcers 11. Abstract 10: Incidence of 30-Day VTE in Adults Tested for SARS-CoV-2 Infection 12. Abstract 11: Neonatal SARS-CoV-2 Infections in Breastfeeding Mothers 13. Abstract 12: Routine Early Angiography in Patients with ROSC after OOHCA 14. Abstract 13: Indications for CT in Older Adult Patients with Minor Head Injury 15. Abstract 14: IV Chlorpromazine vs. IV Prochlorperazine for Acute Migraine 16. Abstract 15: Low-Dose Ketamine for Acute Pain Control in the ED 17. Abstract 16: Regional Analgesia And Delirium In Older Adults with Rib Fractures 18. Abstract 17: Topical Ketamine as a Local Anesthetic to Reduce Venipuncture Pain 19. Abstract 18: Trial of Psilocybin versus Escitalopram for Depression 20. Abstract 19: TXA for the Prevention of Blood Loss after Cesarean Delivery 21. Abstract 20: ETCO2 Value vs. Blood Gas PCO2 Value in the ED 22. Abstract 21: Accuracy of Practitioner Estimates of Probability of Diagnosis 23. Abstract 22: United States’ Performance on Emergency Department Throughput 24. Abstract 23: FASTPASS for Patients With Gallbladder Disease and Appendicitis 25. Abstract 24: Opportunities for Vaccination in Kids Experiencing Homelessness 26. Ultra Summary 27. Time To Talk A Little Nerdy: Post Hoc Power Calculations 28. Farewell Anand Swaminathan, MD FAAEM • Jenny Beck-Esmay, MD • Jess Monas, MD • Ken Milne, MD • Mike Menchine, MD • Sanjay Arora, MD

Jessica Mason and Larissa May discuss the CDC changes for STI treatment. 1. STI Treatment Update 2021 Jessica Mason, MD • Larissa May, MD

Mel summarizes what we know about the Delta variant and the current vaccine effectiveness. 1. EM:RAP 2021 July 26th Breaking News: Delta Variant COVID-19 and Vaccine Effectiveness Mel Herbert, MD MBBS FAAEM

Stuart and Sean discuss Rattlesnake bite treatment. 1. Rattlesnake Bites on the Rise Sean Nordt, MD PharmD FAAEM • Stuart Swadron, MD, FRCPC

Amal breaks down what we know about COVID-19’s effects on the heart. 1. Cardiological Manifestations of COVID-19 Amal Mattu, MD FAAEM • Anand Swaminathan, MD FAAEM

Ilene Claudius sits down with Drs. Hannah Janeway and Clinton Coil to educate us about transgender patients in the emergency department. 1. Transgender Patients in the Emergency Department Clinton Coil, MD • Hannah Janeway, MD • Ilene Claudius, MD

July EMA covers 24 great papers, abstracted and dissected by Sanjay and Mike. Jenny and Jess follow up with their Ultra Summary and Ken and Swami defeat the Semmelweis Reflex. 1. Introduction 2. Abstract 1: Effect of Driving on Podcast Knowledge Acquisition and Retention 3. Abstract 2: Single-Dose Long-Acting IV Antibiotic for Skin Infections 4. Abstract 3: Incidence of ICH in Survivors of Out of Hospital Cardiac Arrest 5. Abstract 4: Dorsal Digital Nerve Block vs. Subcutaneous Volar Nerve Block 6. Abstract 5: Hemodynamic Effects of Induction Agents for Trauma Intubations 7. Abstract 6: High-Sensitivity Cardiac Troponin in Patients with Suspected ACS 8. Abstract 7: Temporal Release of High-Sensitivity Cardiac Troponin in Humans 9. Abstract 8: Left Anterolateral Thoracotomy vs. Bilateral Clamshell Thoracotomy 10. Abstract 9: Prehospital TXA and Outcomes of Severe Traumatic Brain Injury 11. Abstract 10: Cephalosporin Resistance and Discordant Antibiotics in Febrile UTIs 12. Abstract 11: Impact of Young Age on Outcomes of ED Procedural Sedation 13. Abstract 12: Umbilical Cord Management Strategies of Preterm Infants 14. Abstract 13: Contamination Rates of Methods of Urine Culture Collection in Kids 15. Abstract 14: Influence of Gender on Urine Dipstick and Automated Urinalysis 16. Abstract 15: Bands as a Predictor of Bloodstream Infection and Mortality 17. Abstract 16: Effect of Osteopathic Manipulative Treatment in Low Back Pain 18. Abstract 17: Intubations for Pediatric Patients in Pediatric and General EDs 19. Abstract 18: Kussmaul’s Sign for the Diagnosis of Right Ventricular MI 20. Abstract 19: Ultrasound in ED Patients with Nontraumatic Undifferentiated Shock 21. Abstract 20: Pediatric Pneumonia: The SAFER Randomized Clinical Trial 22. Abstract 21: Interruptions and Collaboration During Shift-End Handoffs 23. Abstract 22: Association Between Shift Work and Cognitive Performance 24. Abstract 23: Is the ED an Inappropriate Venue for Code Status Discussions? 25. Abstract 24: Telehealth for Emergency Department Patients with Severe Cellulitis 26. Ultra Summary 27. Time To Talk A Little Nerdy: Defeating the Semmelweis Reflex 28. Farewell Anand Swaminathan, MD FAAEM • Jenny Beck-Esmay, MD • Jess Monas, MD • Ken Milne, MD • Mike Menchine, MD • Sanjay Arora, MD

Welcome to July EM:RAP! This month we cover pediatric DKA, disabilities bias, traumatic arthrotomy, cardiogenic shock, and more... 1. July Introduction 2. Pediatric Pearls: Pediatric DKA 3. Traumatic Arthrotomy 4. Rural Medicine: Consciousness During CPR 5. Healthcare Policy: Part II 6. CorePendium Spotlight: Ranitidine Recall 7. Critical Care Mailbag: The Many Uses of End-Tidal CO2 8. Rick’s Rants: Teamwork and Defining Roles in the ED Part 1 9. Disabilities Bias 10. June EMA Ultra Ultra Summary 11. Diagnosing Cardiogenic Shock 12. July Mailbag 13. July Mega Summary 14. EM:RAP 2021 July German Edition 15. EM:RAP 2021 July Spanish Edition 16. EM:RAP 2021 July Aussie Edition 17. EM:RAP 2021 July PA Edition 18. EM:RAP 2021 July Canadian 19. EM:RAP 2021 July Farsi Edition 20. EM:RAP 2021 July French Edition Amit Maini, FACEM • Anand Swaminathan, MD FAAEM • Ben Shepherd, MD • Brit Long, MD • Catherine Varner, MD • Cedric Dark, MD • Chris Groombridge, FACEM • Darryl Macias MD • Dorothea Hempel, MD • Fred Wu, PA-C • Gita Pensa, MD • Haroun Zayed, MD • Ilene Claudius, MD • Jason Rotoli, MD • Jessica Mason, MD • Jessie Werner, MD • Joseph Ravera, MD • Marc Grossman, MD • Martha Roberts, NP • Mel Herbert, MD MBBS FAAEM • Mike Sharma, PA-C • Natalie Schmitz, PA-C • Neha Raukar, MD • Reza Roodsari, MD • Rick Bukata, MD • Roger Gray, MD • Roshanak Benabbas, MD • Scott Weingart, MD • Sean Nordt, MD PharmD FAAEM • Sergio Alvizu, MD • Skyler Lentz, MD • Solomon Behar, MD • Thomas Fleischmann, MD • Tobias Becker, MD • Vanessa Cardy, MD, FCFP, FRRMS

In addition to 10 noteworthy papers in PCMA, July ROP covers catatonia, psoriatic arthritis, house calls, and a debate about the utility of and evidence for annual wellness exams. 1. July Introduction 2. Reviews and Perspectives with Hobart Lee: The Annual Wellness Visit: An Exposé 3. The Generalist: House Calls 4. Psoriatic Arthritis 5. Rural Medicine: Consciousness During CPR 6. Abstract 1: Effect of Digoxin vs Bisoprolol for Rate Control on Patient QOL 7. Abstract 2: Validation of Canadian TIA Score for Stroke Risk after TIA 8. Abstract 3: CA125 to Detect Ovarian and Non-ovarian Cancer in Primary Care 9. Abstract 4: Long-term Effectiveness of FITs for Proximal and Distal CRCs 10. Abstract 5: External Validation of the PREDICT Prostate Tool 11. Abstract 6: Drugs for Preventing Postmenopausal Osteoporotic Fractures 12. Abstract 7: Hyoscine Butylbromide Vs Acetaminophen for Pediatric Abdo Pain 13. Abstract 8: A Pragmatic, RTC of Gestational Diabetes Screening 14. Abstract 9: Short-Term Topical Tetracaine for Corneal Abrasion Pain 15. Abstract 10: Screening for Asymptomatic Carotid Artery Stenosis 16. July Summary 17. ROP 2021 July Farsi Edition Adrien Selim, MD • Ben Shepherd, MD • Chris Drumm, MD • Heidi James, MD • Hobart Lee, MD • Ken Milne, MD • Mel Herbert, MD MBBS FAAEM • Razieh Hadian, MD • Reza Roodsari, MD • Roger Gray, MD • Steve Brown, MD, FAAFP • Vanessa Cardy, MD, FCFP, FRRMS

Hypothermia post-ROSC has been standard practice for the last 2 decades but, that appears to be changing. Scott Weingart joins us to review the TTM2 trial. 1. The TTM2 Trial Anand Swaminathan, MD FAAEM • Scott Weingart, MD

A high blood glucose measurement is one of the most common reasons for patients with diabetes to present for medical care. But the disposition of these patients depends much more on how they became hyperglycemic and how they look clinically than the actual glucose number that appears in the glucometer window. In this episode, the C3 team tackles the management of hyperglycemia in the diabetic. Patients with DKA and HHS are covered in a separate episode. 1. Approach and Management 2. Case and Review Jessica Mason, MD • Mel Herbert, MD MBBS FAAEM • Stuart Swadron, MD, FRCPC

June 19th is World Sickle Cell Day. Today we hear from Juli Boit and her family’s incredible journey with sickle cell disease and Stuart discusses why we need to know about transcranial doppler screening in the ED. 1. Sickle Cell Disease: Personal Insights and Screening Juli McGown-Boit, NP • Mel Herbert, MD MBBS FAAEM